title: Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma.
abstract: BACKGROUND
  Low central venous pressure (CVP) affects hemodynamic stability and tissue perfusion. This prospective study aimed to evaluate the optimal CVP during partial hepatectomy for hepatocellular carcinoma (HCC).
  
  
  METHODS
  Ninety-seven patients who underwent partial hepatectomy for HCC had their CVP controlled at a level of 0 to 5 mmHg during hepatic parenchymal transection. The systolic blood pressure (SBP) was maintained, if possible, at 90 mmHg or higher. Hepatitis B surface antigen was positive in 90 patients (92.8%) and cirrhosis in 84 patients (86.6%). Pringle maneuver was used routinely in these patients with clamp/unclamp cycles of 15/5 minutes. The average clamp time was 21.4+/-8.0 minutes. These patients were divided into 5 groups based on the CVP: group A: 0-1 mmHg; B: 1.1-2 mmHg; C: 2.1-3 mmHg; D: 3.1-4 mmHg and E: 4.1-5 mmHg. The blood loss per transection area during hepatic parenchymal transection and the arterial blood gas before and after liver transection were analyzed.
  
  
  RESULTS
  With active fluid load, a constant SBP ≥90 mmHg which was considered as optimal was maintained in 18.6% in group A (95% CI: 10.8%-26.3%); 39.2% in group B (95% CI: 29.5%-48.9%); 72.2% in group C (95% CI: 63.2%-81.1%); 89.7% in group D (95% CI: 83.6%-95.7%); and 100% in group E (95% CI: 100%-100%). The blood loss per transection area during hepatic parenchymal transection decreased with a decrease in CVP. Compared to groups D and E, blood loss in groups A, B and C was significantly less (analysis of variance test, P<0.05). Compared with the baseline, the blood oxygenation decreased significantly when the CVP was reduced. Base excess and HCO3- in groups A and B were significantly decreased compared with those in groups C, D and E (P<0.05).
  
  
  CONCLUSIONS
  In consideration of blood loss, SBP, base excess and HCO3-, a CVP of 2.1-3 mmHg was optimal in patients undergoing partial hepatectomy for HCC.
authors.affiliation: Department of Anesthesiology and Department of Hepatic and Biliary Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China. guoya2000@medmail.com.cn.
authors.forename: Cheng-Xin
authors.initials: CX
authors.lastname: Lin
authors.forename: Ya
authors.initials: Y
authors.lastname: Guo
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Guang-Ying
authors.initials: GY
authors.lastname: Zhang
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Huang
authors.forename: Wen-Zheng
authors.initials: WZ
authors.lastname: He
authors.forename: Eric C H
authors.initials: EC
authors.lastname: Lai
mesh_terms: D000136:Acid-Base Equilibrium; D000328:Adult; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000503:physiopathology / Q000601:surgery*; D002496:Central Venous Pressure; D002681:China; D005260:Female; D005440:Fluid Therapy; D006498:Hepatectomy / Q000295:instrumentation*; D006801:Humans; D008113:Liver Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D061646:Operative Time; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome